Cerebrovascular Complications and Infective Endocarditis: Impact of Available Evidence on Clinical Outcome

Table 1

Indications and timing of surgery in left-sided valve IE (native valve endocarditis and prosthetic valve endocarditis) ESC-EACTS 2015 Guidelines [11].

Heart failure	Surgical Timing
Aortic or mitral NVE or PVE with severe acute regurgitation, obstruction or fistula causing refractory pulmonary oedema or cardiogenic shock	Emergency; (Class I - Level of recommendation B)
Aortic or mitral NVE or PVE with severe regurgitation or obstruction causing symptoms of HF or echocardiographic signs of poor haemodynamic tolerance	Urgent; (Class I - Level of recommendation B)
Uncontrolled infection
Locally uncontrolled infection (abscess, false aneurysm, fistula, enlarging vegetation)	Urgent; (Class I - Level of recommendation B)
Infection caused by fungi or multiresistant organisms	Urgent/Elective; (Class I - Level of recommendation C)
Persisting positive blood cultures despite appropriate antibiotic therapy and adequate control of septic metastatic foci	Urgent; (Class II - Level of recommendation A)
PVE caused by staphylococci or non-HACEK gram-negative bacteria	Urgent/Elective; (Class II - Level of recommendation A)
Prevention of embolism
Aortic or mitral NVE or PVE with persistent vegetation >10 mm after one or more embolic episode despite appropriate antibiotic therapy	Urgent; (Class I - Level of recommendation B)
Aortic or mitral NVE with vegetation >10 mm, associated with severe valve stenosis or regurgitation, and low operative risk	Urgent; (Class II - Level of recommendation A)
Aortic or mitral NVE or PVE with isolated very large vegetation (> 30 mm)	Urgent; (Class II - Level of recommendation A)
Aortic or mitral NVE or PVE with isolated large vegetation (>15 mm) and no other indication for surgery	Urgent; (Class II - Level of recommendation B)